Clinical Billing Integrity Lead Analyst (Genomics)

TL;DR

Clinical Billing Integrity Lead Analyst (Genomics): Ensuring that utilization requests and claim submissions align with payer medical necessity rules and requirements with an accent on clinical documentation accuracy and appeal success. Focus on analyzing data trends, managing prior authorization denials, and collaborating with internal clinical teams to optimize reimbursement processes.

Location: Must be based in the United States

Salary: $100,000 - $120,000 USD

Company

hirify.global is a leader in genomic testing and interpretation services, dedicated to providing actionable health insights to inform diagnosis and improve patient care through large-scale clinical data.

What you will do

• Lead cross-functional clinical integrity efforts to ensure adherence to medical necessity rules and payer requirements.
• Review and resolve prior authorization and claim denials, identifying discrepancies in clinical documentation and coding.
• Create clinical materials such as letters of medical necessity, pricing justifications, and appeal templates.
• Analyze data trends using visualization tools like PowerBI and Tableau to identify opportunities for team expansion.
• Integrate new technology for clinical information summarization across pre- and post-test teams.
• Provide insights to Market Access regarding payer-specific coverage gaps and industry standard misalignments.

Requirements

• Master's Degree in Genetic Counseling or a related field required.
• Certification by the American Board of Genetic Counseling (ABGC) or equivalent required.
• Genetic counseling state licensure as required by law.
• Minimum of 3 years of experience, with preference for lab or payer environments.
• Extensive experience with clinical documentation and medical coding (CPT, ICD-10, HCPCS).
• Demonstrated experience in genetic and molecular billing operations and medical necessity criteria.

Culture & Benefits

• Comprehensive health, dental, vision, and life insurance coverage.
• 401k Retirement Savings Plan with company participation.
• Up to 22 weeks of fully paid parental leave for U.S. employees.
• Financial support of up to $25K annually for fertility, adoption, or surrogacy.
• Employee Stock Purchase Plan and various employee discounts.
• Collaborative, fast-moving environment focused on patient outcomes and scientific excellence.